Individual
MR. GERARD W KOTTENBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW LAC
Contact information
Practice address
510 4TH ST S, FARGO, ND 58103
(701) 476-7240
(701) 476-7269
Mailing address
510 4TH ST S, FARGO, ND 58103
(701) 476-7240
(701) 476-7269
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1540
ND
1041C0700X
Clinical Social Worker
LICSW1832
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19120
—
ND
Enumeration date
09/07/2006
Last updated
09/11/2025
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